More About Diabetic Meter Control Solution

I sent the postcard back to my heavily advertised diabetes supply vendor, but before receiving it they called me to ask if I was ready to reorder. As my telephone contact went down the list, I said I did not want her company's brand of glucose meter control solution because I had problems with it (accuracy) and had spoken with the company's quality control department.  I asked for the meter manufacturer's brand of control solution but was told that the vendor only supplied its own brand and if I didn't want their (?defective?) brand, they wouldn't supply me with the control solution at all.

If you are diabetic, you know that frequent accurate testing and control of blood glucose prevents heart attacks, strokes, kidney damage, hypoglycemic coma and other serious injuries.  The control solution is an important element in informing you when your meter or testing strips are producing errors which may result in serious, expensive and preventable patient injury. 

Contrary to the company's promise, no one from their quality assurance department had given me additional information about their investigation of my complaint.  I guess that no one from the FDA reads my blog since I haven't heard from them, either.  Nor from the Inspector General's Office of Legal Counsel.

So, who is minding the store on quality and value for price of the products which the federal government is paying the vendor to supply to Medicare beneficiaries who are diabetic? 

If you have had similar problems with  vendors of Medicare-funded diabetic supplies, I strongly urge you to contact Medicare directly (see the link above).   Maybe if enough people call, someone will pay attention to be sure that the federal government, and its Medicare population, get the quality of diabetic test supplies they deserve and pay for.

Diabetes: Beware of Your Glucose Meter Control Solution

Today, I received a call from a reputable medical supply distributor's quality assurance person in response to a letter I sent complaining that their brand of control solution for a nationally distributed brand of glucose meters and test strips gave lower values than the name brand manufacturer's control solution. While this might seem like a minimal technical issue, it has practical implications for patients who work hard (and shed blood in the process) to maintain "diabetes control" - by keeping their blood sugar within specific ranges.  Too high, and kidney, visual and neurologic problems may develop; too low and the patients may suffer strokes or pass out.  When patients and their physicians cannot easily tell whether glucose meters are accurate, or how inaccurate they are, trouble follows.

The conversation led me to conclude that the company was not communicating well with its customers and lettering them know up front, clearly and unequivocally that there was a problem with its control solution. Someone in the company had made the decision to obfuscate and should take public responsibility. Meanwhile, patients, physicians, Medicare (as a payer) and the FDA should ask: what is going on here?  Diabetes is a common, potentially fatal and incapacitating disease which costs patients, insurers and the federal and state governments billions of dollars each year.  Let's get the diabetes glucose monitor control solution issue resolved.

HHS SAYS: TASTES GOOD AND IS GOOD FOR YOU!

WOW - good news for all except chocolate Easter bunnies.

Eric Ding,  a Harvard School of Public Health epidemiologist, reports that Flavonoids are antioxidants, commonly found in fruits and vegetables. A systematic review and pooling of randomized trials found that consumption of cocoa rich in flavonoids (i.e., dark chocolate)  may improve risk factors for heart disease and diabetes.

The release states that “Higher cocoa flavonoid consumption reduced systolic blood pressure, reduced LDL cholesterol, the bad cholesterol, increased HDL cholesterol, the good cholesterol.”

Does It All Come Down To This? You Are Stuck With Your Genes, But Can Do Something About Telomere Length

Last night's "Gerald and Sally DeNardo Lectureship" at Santa Clara University featured the University of California at San Francisco's Elizabeth Blackburn, Ph.D., 2009 Nobel Prize winner in the Physiology of Medicine. Speaking about telomeres, of which you, the reader have billions (2 per chromosome, 23 pairs of chromosomes per cell and more than 100,000,000,000 cells in your body), Professor Blackburn likened the full-length telomere to the intact tip of a ribbon shoelace, a structure which prevents unraveling and destruction.

Blackburn's research has disclosed that certain unicellular organisms, when undisturbed, have  built-in systems for preserving the length of each telomere through multiple cell divisions but that laboratory interference with that length-preservation results in shortened cell life (loss of immortality).  Going further, she and other scientists have discovered cellular mechanisms for preserving the length of the telomeres and scientific means for interfering with those cellular mechanisms.

People are not unicellular organisms living in Walden Pond, but Blackburn's discoveries have also demonstrated that peoples' lifetime events which result in shortened telomeres lead to the ability to predict life-shortening diseases including cardiovascular disease and diabetes. The events are not genetic, as much as environmental and the good news is that some of them are under society's and our individual control. The bad news is that our population has not had convincing serious long-term commitment to doing things which stabilize or lengthen telomeres, improve our resistance to diseases, lengthen lives and reduce the cost of health care.

Blackburn cited adverse childhood events, chronic stress (including adult post traumatic stress disorder, pessimism and, in men,  hostility) as factors which she can associate with telomere-shortening and a corresponding poor survival prognosis. Stabilization and perhaps lengthening of telomeres is associated with increasing education, exercise and stress reduction.

So turn off the television, get off your rear end, take a pleasant walk, find sensible methods to relieve your stresses and stabilize (and lengthen?) your telomeres.  It is likely that these simple acts will help you to live better and longer! You can also stop blaming your parents for the "bad" genes they gave you since most of your health problems may stem from your own habits and environment.

What Do Hearing Aids, Diaphragms, Condoms & Diabetes Glucose Meters Have in Common?

Quick answer: none of them work when left, unused, in a bedroom drawer.

My focus today is on diabetes and my point is: get a reliable meter (your insurer may have specific models available for you) and test frequently enough (3-4 times a day every day) so that you become the super expert on your diabetes. How does your body react to your medicine? When does your medicine "kick-in"? What are your high and low periods for glucose?  When your glucose is high - how do you feel?  When your glucose is low, how do you feel? What foods raise your glucose level and how soon after eating them does your glucose rise?  When does it drop again? Modern meters give reads which can be recorded in a logbook, or, using computer software for a suitable meter, downloaded, printed and in deliverable form so that your  doctor can review your daily records each month and you and your doctor can discuss the findings while your doctor also checks your retina for diabetic changes, your feet for diabetic problems, the parts of your body between your head and your feet, and some appropriate laboratory testing, and then gives you advice on management.

With this information you have a much better understanding of your diabetes, its treatment, and how you can control your sugars!

TV commercials, ads in newspapers and magazines and brochures  tout the benefits of new free give-away glucose meters for diabetics from companies which didn't exist a year ago. I chose my meter with my physician and confirmed the wisdom of my purchase by looking - not at my TV set or throwaway ad - but in Consumers' Union (Consumer Reports) which rated a variety of meters in terms of cost and accuracy a year or two ago.  The initial cost of a meter is only a small part of its actual cost: glucose test strips, lancets and other simple materials used in testing all are expensive which makes insurance coverage highly beneficial. Some meters are more accurate and reliable than others. The best lancets (which are not significantly more expensive) have very fine needles which are essentially painless. Some meters use strips which require a large blood drop which can be difficult when your fingers are cold, or your hands are stiff, arthritic and have impaired feeling sensation.

A practical example: if at 11:30 AM your glucose is high, is it because your medicine hasn't acted yet, because you ate late, because you ate too much for breakfast, or because you skipped your morning walk? If you've been testing regularly you might know that instead of taking more medicine, you should take a 30 minute walk and then retest to probably find that your glucose came down because the medicine had more time to work and you burned off glucose with your moderate exercise. Wow - doesn't it feel good to be in control?

A Tale of Two Companies

In a recent blog, I described problems with one highly advertised diabetic supply company which I did not name because my policy is to praise in public and criticize privately.

In contrast, today's blog describes the straightforward and appropriate response which I received from Liberty Medical Supply's COO. A refreshing no-nonsense letter, strikingly different from the other company's responses. And because of the difficulties I experienced, without hesitation Liberty offered (and I accepted) to provide me with Accu-Chek lancets, a clearly superior product.

Here is Liberty's Chief Operating Officer response to my letter criticising Liberty's "generic" lancets:

"Dear Dr. Kaplan,
Thank you for your thoughtful letter regarding Liberty and One Touch lancets. You bring up a valid point regarding the comfort levels provided by different lancets, and I wanted to reply to you personally.

"To give you some background, over the past six months, all Liberty lancets have been moved from 28 gauge to 30 gauge, compared to One Touch lancets, which are 25 gauge.

"For you, and all patients with diabetes, finding the least painful method of obtaining a blood sample is crucial. I am sorry that you were not pleased with Liberty's lancets.

"As of this date, Liberty's lancet manufacturer is complying with our instruction to install new molds, which should eliminate the plastic problem and the slight bend that can occur on the shaft when the plastic cap is twisted off. Also, the new needles have a tri-beveled and electro-polished finish to improve the discomfort of finger sticking. And finally, by May 2009, all Liberty lancets will be made on fully robotic systems that will significantly tighten tolerance levels and quality in lancet manufacturing.

"At Liberty, we understand the importance of lancets in managing diabetes and we are
constantly looking to improve upon the products we offer, Again, Dr. Kaplan, thank you for contacting us. If I can be of further assistance, do not hesitate to contact me directly at 772-398-5822.

Sincerely,
Keith W. Jones
Chief Operatlng Officer
Liberty Medical Supply, Inc."

Liberty Medical

Clinical Competence or Electronic Medical Records?

It may seem unfair to ask: "do you favor clinical competence over electronic medical records"? But today, the United States doesn't have enough dollars to pay for health care for its entire population. Use of billions of dollars of scarce resources to pay for electronic medical records systems will divert money from training competent clinicians in evidence-based medicine and may have a detrimental effect on health care.

Pysician, nurse, and nurse practitioner training programs stress the mantra: show us the evidence for the diagnosis you make and the treatment you prescribe. Unfortunately, health systems administrators, insurers, politicians and others who control the flow of health care dollars are not required to show solid evidence supporting their rush to electronic medical records. The information technology industry claims superiority for its products. Politicians, bureaucrats and administrators wax enthusiastic about their chance to spend billions of dollars on technology which does not yet demonstrate patient health outcome superiority as compared to traditional paper records and systems. The issue isn't whether a computer generates a pretty report for a mid-level administrator; it is whether the patient lives or dies or suffers severe medically unnecessary complications or pain.

Citing two studies of handheld electronic medical record systems, a 2006 Canadian abstract did not find conclusive evidence of a net benefit from the use of the handheld medical record system. It did report an increase in the number of wrong or redundant diagnoses (http://www.biomedcentral.com/1472-6947/6/26/abstract downloaded 5/11/2008).

Crosson and others reported the effects of electronic medical records on diabetes care in an NIH funded study (http://www.annfammed.org/cgi/content/full/5/3/209 downloaded 5.11.2008). Statistical analyses demonstrated no evidence of an improvement in ultimate outcome. Surprisingly ". . . . patients with diabetes in practices that did not have an EMR were significantly more likely to have received care that met the guidelines for processes of care, treatment, and intermediate outcomes".

There is literature claiming that electronic medical records systems show a good return on investment (http://www.medicalnewstoday.com/articles/76786.php downloaded 5/11/2008). Where are comparable studies demonstrating that the money spent for such expensive systems show a net benefit to patient outcomes. Where is the answer to the mantra: show us the evidence?